SA urged to tackle NHI as one

Coun­tries with na­tional health in­surance sup­port pri­vate-pub­lic part­ner­ships

CityPress - - News - ZINHLE MAPUMULO zinhle.mapumulo@city­press.co.za

Coun­tries that have es­tab­lished na­tional health­care sys­tems have ad­vised gov­ern­ment to con­sider part­ner­ing with the pri­vate sec­tor to en­sure the Na­tional Health In­surance (NHI) plan is suc­cess­ful here. Rep­re­sen­ta­tives from these coun­tries say that the only way to si­lence re­sis­tance while en­sur­ing that every ci­ti­zen has ac­cess to qual­ity health­care is to forge a healthy joint ven­ture with the pri­vate sec­tor.

Gov­ern­ment is gear­ing up for the sec­ond phase of the NHI’s fi­nance sys­tem, which was launched six years ago. This is part of its ob­jec­tive to abol­ish the coun­try’s two-tier health sys­tem by pool­ing funds to en­able it to pro­vide qual­ity health­care ser­vices to all South Africans based on need, and ir­re­spec­tive of in­come.

Once fully im­ple­mented – by 2025, ac­cord­ing to the health depart­ment – the NHI sys­tem should work the same way med­i­cal schemes do. Pa­tients will go to ac­cred­ited doc­tors and hos­pi­tals with­out pay­ing up­front, and the NHI fund will re­im­burse doc­tors and hos­pi­tals for the ser­vices pro­vided.

Uni­ver­sal health­care and its im­ple­men­ta­tion were dis­cussed among lo­cal and in­ter­na­tional ex­perts at the Board of Health­care Fun­ders con­fer­ence in Cape Town this week.

Dr Clarence Mini, the board’s act­ing man­ag­ing di­rec­tor, urged the depart­ment of health to con­sider part­ner­ships with the pri­vate health sec­tor as it rolled out the NHI scheme.

Or­gan­ised un­der the banner “pri­vate sec­tor em­brac­ing uni­ver­sal health­care”, he said the pri­vate sec­tor had the re­sources that the pub­lic sec­tor would need to sup­port and help drive the in­surance sys­tem.

“The jour­ney to­wards uni­ver­sal health­care will present new chal­lenges. How­ever, the prom­ise of a part­ner­ship, along with po­lit­i­cal will and good lead­er­ship, may make the jour­ney ahead a lot eas­ier than we have all imag­ined,” Mini said.

In­ter­na­tional speak­ers warned that, while the im­ple­men­ta­tion of the NHI scheme sounded easy on pa­per, it would be a dif­fer­ent story in re­al­ity.

Lessons from Oba­macare

Dr Elizabeth Fowler, vice-pres­i­dent for global health pol­icy at multi­na­tional John­son & John­son, worked in for­mer US pres­i­dent Barack Obama’s ad­min­is­tra­tion on health­care and eco­nomic pol­icy.

She said South Africa could learn a lot from how the US im­ple­mented its uni­ver­sal health cov­er­age pol­icy, pop­u­larly known as Oba­macare.

She said that, while uni­ver­sal health cov­er­age was a jour­ney worth fight­ing for, it was bet­ter to have the sup­port of the pri­vate health­care sec­tor.

She pointed out that it had taken the US a cen­tury to im­ple­ment Oba­macare: “We have had about 100 years of try­ing to achieve uni­ver­sal cov­er­age in the US, be­gin­ning in the early 1900s and lead­ing up to 2010, when the Af­ford­able Care Act was passed.

“In 2009, when Obama took on health­care, we tried to fo­cus on why the pre­vi­ous at­tempts failed, es­pe­cially in 1993/94 dur­ing for­mer pres­i­dent Bill Clin­ton’s ten­ure. We took a few lessons from that.

“Firstly, the de­bate over health­care was very long and it lost the po­lit­i­cal cap­i­tal.

“Se­condly, a task force com­pris­ing about 500 peo­ple was cre­ated to put to­gether a pro­posal and send it to Congress. That pro­posal an­swered too many ques­tions and had too many de­tails. It was a full, writ­ten pro­posal with lit­tle room for in­put.

“Thirdly, it moved peo­ple out of ex­ist­ing cov­er­age [about two-thirds of the US pop­u­la­tion had pri­vate med­i­cal in­surance] and the Clin­ton pro­posal pro­posed mov­ing ev­ery­body into the new sys­tem. That was threat­en­ing to peo­ple who had cov­er­age they re­ally liked. So it cre­ated a lot of en­e­mies right from the start.

“Fourthly, every stake­holder in the health­care sys­tem – doc­tors, hos­pi­tals, in­surance com­pa­nies and phar­ma­ceu­ti­cal in­dus­tries – was op­posed to it. It made it dif­fi­cult to get things done.”

Fast-for­ward to 2008, when Obama was elected pres­i­dent. The US pub­lished a White Pa­per that laid out a frame­work for health re­form – sim­i­lar to what South Africa has done.

It was fol­lowed by many hear­ings, leg­isla­tive pro­cesses, de­bates and fi­nal votes, which led to its ap­proval in March 2010, Fowler said.

In terms of the politics, Obama pri­ori­tised health­care re­form at a time when the coun­try was go­ing through a re­ces­sion. This did not sit well with pri­vate health­care stake­hold­ers.

“We did an anal­y­sis of each stake­holder in the sys­tem to try to work out what they were afraid of, what they wanted and what they would lose,” said Fowler.

“We fig­ured out how much the pri­vate sec­tor stood to gain from cov­er­ing the unin­sured. We quan­ti­fied this and went back to each stake­holder group to ask if they wanted to come to the ta­ble and also fi­nance cov­er­ing the unin­sured. They agreed.

“The phar­ma­ceu­ti­cal in­dus­try con­trib­uted

$80 bil­lion [R1.04 tril­lion]; the hos­pi­tal in­dus­try, $155 bil­lion. It was im­por­tant to have ev­ery­one at the ta­ble.”

Lessons from Ghana

Nathaniel Otoo, Ghana’s for­mer chief ex­ec­u­tive of­fi­cer of the Na­tional Health In­surance Au­thor­ity, cham­pi­oned a sim­i­lar health re­form.

He said: “The jour­ney to achiev­ing this goal will be long and bumpy.”

Be­fore launch­ing its Na­tional Health In­surance Scheme (NHIS), Ghana’s health sys­tem was twotiered, with a small part of the pop­u­la­tion (20%) af­ford­ing pri­vate health­care and the rest re­ly­ing on the pub­lic sys­tem.

Ghana launched its NHIS in 2003 in re­sponse to the de­cline in pub­lic ac­cess to health­care. Be­cause of its 1980s full user-fee pay­ment sys­tem called Cash and Carry, a min­i­mum per­cent­age of op­er­at­ing costs had been re­cov­ered. Otoo said the aim was to in­crease fi­nan­cial ac­cess to health­care, es­pe­cially for the poor and vul­ner­a­ble.

How­ever, run­ning the NHIS has been a daunt­ing task that has taught the coun­try a few lessons.

Prob­lems in Ghana have in­cluded cit­i­zens’ poor ge­o­graph­i­cal ac­cess to qual­ity health­care ser­vices, en­sur­ing the fi­nan­cial sus­tain­abil­ity of the NHIS, poor reg­u­la­tion in the health sec­tor, in­equitable dis­tri­bu­tion of ser­vices and poor qual­ity of ser­vices.

“With more than 4 000 health fa­cil­i­ties ac­cred­ited by the NHIS to pro­vide ser­vices, and about

11 mil­lion mem­bers, moral haz­ards and mal­ad­min­is­tra­tion in the dis­tri­bu­tion of funds for the pur­poses of ex­pand­ing and sus­tain­ing the NHIS posed a ma­jor chal­lenge,” said Otoo.

De­spite these bat­tles, Ghana’s NHIS has made sig­nif­i­cant progress to­wards pro­vid­ing fi­nan­cial risk pro­tec­tion to its pop­u­la­tion. The pub­lic’s health­seek­ing be­hav­iour has also im­proved.

Otoo urged South Africa to form and strengthen part­ner­ships with the pri­vate health­care sec­tor as it phased in the NHI.

“I be­lieve the pri­vate sec­tor could be a good part­ner for reg­u­la­tion, gov­er­nance, health ser­vice pro­vi­sion, im­prove­ments on qual­ity, in­for­ma­tion sys­tem sup­port, the com­mod­ity sup­ply chain, fi­nan­cial in­tel­li­gence – by way of pro­vid­ing sys­tems to get more funds to im­prove health­care de­liv­ery – as well as cus­tomer care.”

Fowler and Otoo agreed that South Africa was “do­ing the right thing” by forg­ing ahead with uni­ver­sal cov­er­age de­spite re­sis­tance and crit­i­cism.

TALK TO US

Do you agree that a part­ner­ship with the pri­vate sec­tor will help make the NHI scheme a suc­cess?

SMS us on 35697 us­ing the key­word BEN­E­FIT and tell us what you think. Please in­clude your name and prov­ince. SMSes cost R1.50

PHOTO: LISA HNATOWICZ

PUB­LIC SER­VICE The SA Life Im­prove­ment Char­i­ta­ble Trust is a non­profit or­gan­i­sa­tion that spon­sors cataract op­er­a­tions and cornea trans­plants

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